{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T19:30:25Z","timestamp":1789587025686,"version":"build-2803163510"},"reference-count":20,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Integration of pharmacies with physician practices, also known as medically integrated dispensing, is increasing in oncology. However, little is known about how this integration affects drug use, expenditures, medication adherence, or time to treatment initiation.<\/jats:p><\/jats:sec>Objective<\/jats:title>To examine the association of physician-pharmacy integration with oral oncology drug expenditures, use, and patient-centered measures.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cohort study used claims data from a large commercial insurer in the US to analyze changes in outcome measures among patients treated by pharmacy-integrating vs nonintegrating community oncologists in 14 states between January 1, 2011, and December 31, 2019. Commercially insured patients were aged 18 to 64 years with 1 of the following advanced-stage diagnoses: breast cancer, colorectal cancer, kidney cancer, lung cancer, melanoma, or prostate cancer. Data analysis was conducted from May 2023 to March 2024.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Treatment by a pharmacy-integrating oncologist, ascertained by the presence of an on-site pharmacy or nonpharmacy dispensing site.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>Oral, intravenous (IV), total, and out-of-pocket drug expenditures for a 6-month episode of care; share of patients prescribed oral drugs; days\u2019 supply of oral drugs; medication adherence measured by proportion of days covered; and time to treatment initiation. The association between an oncologist\u2019s pharmacy integration and each outcome of interest was estimated using the difference-in-differences estimator.<\/jats:p><\/jats:sec>Results<\/jats:title>Between 2012 and 2019, 3159 oncologists (745 females [27.1%], 2002 males [72.9%]) treated 23\u202f968 patients (66.4% female; 53.4% aged 55-64 years). Of the 3159 oncologists, 578 (18.3%) worked in practices that integrated with pharmacies (with a low rate in 2011 of 0% and a high rate in 2019 of 31.5%). In the full sample (including all cancer sites), after physician-pharmacy integration, no significant changes were found in oral drug expenditures, IV drug expenditures, or total drug expenditures. There was, however, an increase in days\u2019 supply of oral drugs (5.96 days; 95% CI, 0.64-11.28 days; P<\/jats:italic>\u2009=\u2009.001). There were no significant changes in out-of-pocket expenditures, medication adherence, or time to treatment initiation of oral drugs. In the breast cancer sample, there was an increase in oral drug expenditures ($244; 95% CI, $41-$446; P<\/jats:italic>\u2009=\u2009.02) and a decrease in IV drug expenditures (\u2013$4187; 95% CI, \u2013$8293 to \u2013$80; P<\/jats:italic>\u2009=\u2009.05).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Results of this cohort study indicated that the integration of oncology practices with pharmacies was not associated with significant changes in expenditures or clear patient-centered benefits.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.12998","type":"journal-article","created":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T15:33:44Z","timestamp":1716478424000},"page":"e2412998","source":"Crossref","is-referenced-by-count":5,"title":["Cancer Treatment Before and After Physician-Pharmacy Integration"],"prefix":"10.1001","volume":"7","author":[{"given":"Genevieve P.","family":"Kanter","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles"},{"name":"Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pelin","family":"Ozluk","sequence":"additional","affiliation":[{"name":"Elevance Health Inc, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winnie","family":"Chi","sequence":"additional","affiliation":[{"name":"Elevance Health Inc, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Fisch","sequence":"additional","affiliation":[{"name":"Carelon Medical Benefits Management, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Debono","sequence":"additional","affiliation":[{"name":"Carelon Medical Benefits Management, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi B.","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia"},{"name":"Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia"},{"name":"Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mireille","family":"Jacobson","sequence":"additional","affiliation":[{"name":"Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles"},{"name":"Leonard Davis School of Gerontology, University of Southern California, Los Angeles"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin E.","family":"Bekelman","sequence":"additional","affiliation":[{"name":"Penn Center for Cancer Care Innovation, Abramson Cancer Center, University of Pennsylvania, Philadelphia"},{"name":"Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"DeVries","sequence":"additional","affiliation":[{"name":"Elevance Health Inc, Indianapolis, Indiana"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,5,23]]},"reference":[{"issue":"10","key":"zoi240451r1","doi-asserted-by":"publisher","first-page":"e1672","DOI":"10.1200\/OP.22.00136","article-title":"Trends in medically integrated dispensing among oncology practices.","volume":"18","author":"Kanter","year":"2022","journal-title":"JCO Oncol Pract"},{"issue":"6","key":"zoi240451r2","doi-asserted-by":"publisher","first-page":"633","DOI":"10.1200\/JCO.19.02297","article-title":"Patient-centered standards for medically integrated dispensing: ASCO\/NCODA standards.","volume":"38","author":"Dillmon","year":"2020","journal-title":"J Clin Oncol"},{"issue":"7","key":"zoi240451r4","doi-asserted-by":"publisher","first-page":"e1225","DOI":"10.1200\/OP.22.00022","article-title":"Financial impact of medically integrated pharmacy interventions on oral oncolytic prescriptions.","volume":"18","author":"Darling","year":"2022","journal-title":"JCO Oncol Pract"},{"issue":"9","key":"zoi240451r5","doi-asserted-by":"publisher","first-page":"1238","DOI":"10.1001\/jamaoncol.2023.2306","article-title":"Cost of drug wastage from dose modification and discontinuation of oral anticancer drugs.","volume":"9","author":"Lam","year":"2023","journal-title":"JAMA Oncol"},{"issue":"8","key":"zoi240451r6","doi-asserted-by":"publisher","first-page":"625","DOI":"10.1038\/s41573-023-00723-4","article-title":"Trends in the approval of cancer therapies by the FDA in the twenty-first century.","volume":"22","author":"Scott","year":"2023","journal-title":"Nat Rev Drug Discov"},{"key":"zoi240451r8","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.6004\/jnccn.2008.2003","article-title":"NCCN task force report: oral chemotherapy.","volume":"6","author":"Weingart","year":"2008","journal-title":"J Natl Compr Canc Netw"},{"issue":"2","key":"zoi240451r11","doi-asserted-by":"publisher","first-page":"317","DOI":"10.1177\/10775587211013628","article-title":"Assessing the quality of SK&A\u2019s office-based physician database for identifying oncologists.","volume":"79","author":"Valdez","year":"2022","journal-title":"Med Care Res Rev"},{"issue":"6","key":"zoi240451r12","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1001\/jamainternmed.2014.20","article-title":"Primary care access for new patients on the eve of health care reform.","volume":"174","author":"Rhodes","year":"2014","journal-title":"JAMA Intern Med"},{"key":"zoi240451r14","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.jeconom.2020.12.001","article-title":"Difference-in-differences with multiple time periods.","volume":"225(2)","author":"Callaway","year":"2021","journal-title":"J Econom"},{"issue":"22","key":"zoi240451r15","doi-asserted-by":"publisher","first-page":"2401","DOI":"10.1001\/jama.2014.16153","article-title":"Methods for evaluating changes in health care policy: the difference-in-differences approach.","volume":"312","author":"Dimick","year":"2014","journal-title":"JAMA"},{"issue":"3","key":"zoi240451r17","doi-asserted-by":"publisher","first-page":"278","DOI":"10.1001\/jama.2023.10753","article-title":"Utilization management in Medicare Part D oncology drugs, 2010-2020.","volume":"330","author":"Kyle","year":"2023","journal-title":"JAMA"},{"key":"zoi240451r18","doi-asserted-by":"publisher","first-page":"1504","DOI":"10.1200\/JCO.2023.41.16_suppl.1504","article-title":"Prior authorizations for oral anticancer drugs and delayed prescription fills.","volume":"41","author":"Kyle","year":"2023","journal-title":"J Clin Oncol"},{"issue":"suppl 3","key":"zoi240451r19","doi-asserted-by":"publisher","first-page":"1085","DOI":"10.1111\/hesr.v55.s3","article-title":"Organizational integration, practice capabilities, and outcomes in clinically complex Medicare beneficiaries.","volume":"55","author":"Colla","year":"2020","journal-title":"Health Serv Res"},{"key":"zoi240451r3","volume-title":"Report to the Congress: Medicare and the Health Care Delivery System","author":"Medicare Payment Advisory Commission","year":"2016"},{"key":"zoi240451r7","unstructured":"US Food and Drug Administration. Drugs@FDA data files. Accessed March 6, 2024. https:\/\/www.fda.gov\/drugs\/drug-approvals-and-databases\/drugsfda-data-files"},{"key":"zoi240451r9","unstructured":"Community Oncology Alliance. Fact sheet: what is community oncology? 2017. Accessed March 6, 2024. https:\/\/communityoncology.org\/wp-content\/uploads\/2017\/08\/What-is-Comm-Onc.pdf"},{"key":"zoi240451r10","unstructured":"IQVIA. OneKey homepage. Accessed March 6, 2024. https:\/\/www.onekeydata.com\/."},{"key":"zoi240451r13","unstructured":"National Council for Prescription Drug Programs. NCPDP homepage. Accessed March 6, 2024. https:\/\/www.ncpdp.org\/"},{"key":"zoi240451r16","unstructured":"Rios-Avila? F, Sant\u2019Anna? PHC, Callaway? B. CSDID: Stata module for the estimation of difference-in-difference models with multiple time periods. Accessed March 6, 2024. https:\/\/ideas.repec.org\/c\/boc\/bocode\/s458976.html"},{"key":"zoi240451r20","unstructured":"Centers for Medicare and Medicaid Services. Oncology care model. Accessed March 6, 2024. https:\/\/innovation.cms.gov\/innovation-models\/oncology-care"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2819040\/kanter_2024_oi_240451_1715725938.6146.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,23]],"date-time":"2024-05-23T15:33:47Z","timestamp":1716478427000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2819040"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,23]]},"references-count":20,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.12998","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,5,23]]}}}